Healthcare Provider Details

I. General information

NPI: 1528672052
Provider Name (Legal Business Name): SARAH NICOLE KATZ AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

IV. Provider business mailing address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-8883
  • Fax:
Mailing address:
  • Phone: 760-322-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95015330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: